Rubella Virus
Upendo Kibwana
Microbiology and Immunology Department
MUHAS
• Classified as a togavirus, genus Rubivirus.
• It is an enveloped ssRNA virus, with a single antigenic type that
does not cross-react with other members of the togavirus
group
• Relatively unstable and is inactivated by lipid solvents, trypsin,
formalin, ultraviolet light, low pH, heat, and amantadine.
Epidemiology
• Rubella occurs worldwide.
• Rubella is a human disease. There is no known animal
reservoir.
• Spread from person to person via airborne transmission or
droplets shed from the respiratory secretions of infected
persons.
• Peak in countries with temperate climates
• Common in children aged 5-10 yrs
• Infants with CRS may shed virus for a year or more
• Life long Immunity after infection
• Availability of vaccine has eliminated Rubella in most countries
Pathogenesis
• The virus is transmitted via droplets.
• Following respiratory transmission of rubella virus,
replication of the virus is thought to occur in the
nasopharynx and regional lymph nodes. A viremia occurs 5
to 7 days after exposure with spread of the virus throughout
the body.
• Transplacental infection of the fetus occurs during viremia.
Fetal damage occurs through destruction of cells as well as
mitotic arrest.
Clinical manifestation
1. Acquired Rubella
• The disease resembles measles. 50% of suspected measles
cases are determined to be rubella.
• Incubation period, 14 days
• In children, rash is the first manifestation
• In older children and adults, there is often a 1 to 5 day prodrome with low-
grade fever, malaise, lymphadenopathy, and upper respiratory symptoms
preceding the rash.
• The rash usually occurs initially on the face and then progresses from head to
foot
• Arthralgia and arthritis also occurs in adults
• Other symptoms of rubella include conjunctivitis, testalgia, or orchitis
2. Congenital Rubella Syndrome
• Infection with rubella virus is most severe in early gestation.
• The virus may affect all organs and cause a variety of congenital
defects.
• Infection may lead to fetal death, spontaneous abortion, or
premature delivery.
• Defects are rare when infection occurs after the 20th week of
gestation
• Deafness is the most common and often the sole
manifestation of congenital rubella infection, especially after
the fourth month of gestation
• Eye defects, including cataracts, glaucoma, retinopathy, and
microphthalmia may occur.
• Manifestations of CRS may be delayed from 2 to 4 years.
• Diabetes mellitus appearing in later childhood occurs
Complications
• Not common, but they generally occur more often in adults than in
children.
• Arthralgia or arthritis may occur in up to 70% of adult women who
contract rubella, but it is rare in children and adult males.
• Encephalitis occurs in one in 6,000 cases, more frequently in adults
(especially in females) than in children.
• Additional complications include orchitis, neuritis, and a rare late
syndrome of progressive panencephalitis.
Laboratory Diagnosis
• viral culture for rubella ;Rabbit kidney cells, Vero cells
• PCR detection of rubella virus
• Serological tests to demonstrate of a significant rise in IgG
antibody from paired acute- and convalescent-phase sera.
• Specimen: nasal, blood, throat, urine and cerebrospinal fluid
Treatment and Prevention
• The disease is mild and self limited
• No specific treatment
• Isolation and quarantine
• Acetaminophen for symptomatic relief
• Prevention via vaccine; MMR
• Children, teenage girls
